Findings Letter for Wicomico County Detention Center
Mr. L. Russell Molnar
President
Wicomico County Council
P.O. Box 870
Salisbury, MD 21803-0870
Re: Wicomico County Detention Center
September 9, 2002
Dear Mr. Molnar:
On October 5, 2000, we notified you of our intent to
investigate the Wicomico County Detention Center ("WCDC" or "the Detention Center") pursuant to the Civil Rights of
Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997 et seq.
On January 26-28, 2001, we conducted an on-site inspection of the
Detention Center with expert consultants in correctional medical
and mental health care, penology and environmental health and
safety. While at WCDC, we interviewed correctional and
administrative staff, inmates and medical and mental health care
providers. In addition, we have reviewed an extensive number of
documents, including policies and procedures, incident reports,
medical records, use of force records and staff disciplinary
records. At the end of our on-site inspection, we and our
consultants discussed with County officials and the Detention
Center staff our preliminary concerns regarding the conditions at
WCDC. Consistent with the statutory requirements of CRIPA, we
write to advise you of the results of our investigation.
As an initial matter, we commend the staff of the Detention
Center for their helpful and professional conduct throughout the
course of the investigation. The staff have cooperated fully
with our investigation and have provided us with substantial
assistance.
WCDC opened for operation in 1988, and is the largest
detention center on the Eastern Shore of Maryland. The Wicomico
County Department of Corrections operates WCDC. The facility
houses both men and women, including pre-trial detainees, inmates
serving sentences of 18 months or less and Immigration and
Naturalization Service ("INS") detainees. Although both male and
female INS detainees were housed at WCDC at the time of our tour,
we understand that currently it only houses male INS detainees.
According to Detention Center officials, WCDC has a rated
capacity of 535 inmates and detainees.
The Detention Center has seven primary housing areas: 1) Central Booking, containing male and female holding cells and
suicide-watch cells; 2) A-Block for INS female detainees and
general population female inmates; 3) B-Block for general
population male inmates; 4) C-Block for general population male
inmates and INS male detainees; 5) Special Housing, containing
five disciplinary segregation cells; four administrative
segregation cells; and four cells for detainees with mental
health designations; 6) Work Release Dormitory for male inmates;
and 7) Work Release Dormitory for female inmates.
Our investigation revealed that WCDC provides adequate non-emergency medical care to the general population and implemented
an appropriate mental health screening program, beginning in July
2000. As described more fully below, we also conclude that
certain conditions at WCDC violate the constitutional rights of
inmates and detainees housed at the Detention Center. We find
deficiencies at WCDC in medical care, specifically in the areas
of chronic care, access to medical care for inmates and detainees
in segregation, and tuberculosis screening; mental health care,
specifically in the areas of mental health treatment and
medication distribution; inmate and detainee safety; and
environmental health and safety. In addition, overcrowding in
the facility exacerbates many of these deficiencies.
I. Legal Framework
CRIPA authorizes the Department of Justice to investigate
and take appropriate action to enforce the constitutional rights
of inmates and detainees. 42 U.S.C. § 1997a. With regard to
sentenced inmates, the Eighth Amendment's ban on cruel and
unusual punishment "imposes duties on [prison] officials, who
must provide humane conditions of confinement; prison officials
must ensure that inmates receive adequate food, clothing,
shelter, and medical care." Farmer v. Brennan, 511 U.S. 825, 832
(1994). Prison officials have a further duty "to protect prisoners from violence at the hands of other prisoners." Id. at
833. The Eighth Amendment protects prisoners not only from
present and continuing harm, but from the possibility of future
harm as well. Helling v. McKinney, 509 U.S. 25, 33 (1993). It
also forbids excessive physical force against prisoners. Hudson
v. McMillian, 503 U.S. 1 (1992). Medical needs include not only
physical health needs, but mental health needs as well. Bowring
v. Godwin, 551 F.2d 44, 47 (4th Cir. 1977); Young v. City of
Augusta ex rel Devaney, 59 F.3d 1160 (11th Cir. 1995). With
regard to pre-trial detainees, the Fourteenth Amendment prohibits
imposing conditions or practices on detainees that are not
reasonably related to the legitimate governmental objectives of
safety, order and security. Bell v. Wolfish, 441 U.S. 520
(1979).
II. Medical Care
WCDC provides inadequate medical services in the following
areas: chronic care; access to medical care; and tuberculosis
screening. As a result of these deficiencies, inmates and
detainees do not receive adequate evaluation or treatment for
their illnesses, particularly individuals with chronic
conditions. The deficiencies in WCDC's medical care are largely
a result of inadequate staffing and a lack of policies and
procedures. These failings increase the risk of serious harm or
death to the population at the Detention Center.
A. Chronic Care
The most problematic and potentially dangerous component of
WCDC's medical care is its screening, monitoring and follow-up
care of inmates and detainees with chronic medical conditions,
such as hypertension, diabetes, asthma and AIDS. Individuals
with chronic medical conditions require ongoing, routinized care
to prevent progression or complications of their illnesses. The
Detention Center does not have a functioning system for managing
chronic illnesses, largely due to the physician's lack of time to
manage chronic illnesses and the lack of chronic care policies
and procedures. These deficiencies create a risk that inmates
and detainees will suffer serious and preventable medical harm.
Our review of medical records of patients with chronic
illnesses revealed a significant number of inmates and detainees
who received inadequate monitoring and treatment, including a
failure to provide important routine tests. For example, the
Detention Center did not check the blood sugar level of an
insulin dependent diabetic inmate until five months after his
admission to WCDC. Medical providers should check blood sugar
levels in insulin dependent diabetics no less than weekly and,
depending on the patient, as frequently as several times a day.
Moreover, despite complaints of blurred vision from the same
inmate, WCDC did not refer him to an eye doctor until four months
after his complaints. Diabetics may lose significant vision if
not evaluated regularly by an eye doctor and immediately when
symptoms of visual impairment occur.
In another case, a 54 year-old inmate with a history of
chest pain and possible hyperthyroidism entered WCDC in June
2000. Intake notes indicated that the Detention Center should
obtain and evaluate the patient's medical records from a previous
facility concerning the history of possible hyperthyroidism.
WCDC failed to do so and did not conduct any further evaluation
of his possible thyroid disease. In November 2000, the inmate
complained of chest pain and WCDC ordered an electrocardiogram
("EKG"). But the patient did not receive the EKG until January
2001. The test disclosed serious heart problems. It is
medically inappropriate and potentially life-threatening to wait
over a month to conduct an EKG following complaints of chest pain
in a 54 year-old man with possible thyroid disease.
The Detention Center also did not provide the necessary
follow-up monitoring of hypertensive inmates to determine the
efficacy of their therapies and the current state of their blood
pressures. Chronic uncontrolled high blood pressure may damage
the heart, kidneys and brain.
For another patient, a detainee with a history of hepatitis C, medical staff ordered blood tests to determine the
status of the hepatitis. WCDC, however, failed to provide the
tests or to conduct any follow-up evaluation. These failures may
contribute to a very serious liver infection.
B. Access to Medical Care
Our review of medical records indicated that WCDC ordinarily
provides timely access to non-emergency medical services for its
general population. Inmates and detainees in the general
population gain access to non-emergency medical care by
completing sick call forms. An evening nurse picks up these
forms during medical rounds five days a week, which are triaged
the following morning.
WCDC provides an unacceptably lower level of sick call
access to inmates and detainees in the Behavioral Adjustment Unit
("BAU"). Due to medical staffing deficiencies and a lack of
written policies, WCDC does not have a systematic method for
inmates and detainees in the BAU to speak directly with medical
staff, such as conducting formal medical rounds. Instead,
inmates and detainees in this unit must rely primarily upon
correctional staff to communicate their sick call requests to
medical staff. This practice compromises the quality and
timeliness of treatment since individuals do not have an
opportunity to speak privately and directly with medical staff.
Additionally, our review of medical records revealed
instances in which WCDC failed to provide indigent inmates with
adequate medical treatment. In particular, the Detention Center
refused to provide medically indicated eyeglasses to inmates
unable to pay for them. Treatment decisions must be based upon
appropriate medical assessments of the need for treatment, not on
an individual's ability to pay for the treatment.
C. Tuberculosis Screening
Our review of medical records revealed numerous instances
where WCDC did not perform tuberculosis skin tests ("PPDs") on
inmates and detainees at intake because they stated that they had
tested negative in the community or in other facilities. WCDC
does not require any documentation of the purported negative
tests, relying instead solely on individuals' self-reports.
Self-reported PPD results are frequently inaccurate because many
individuals wish to avoid injections. Tuberculosis screening of
all new intakes is an important part of correctional health care
because inmates and detainees are frequently from populations at
high risk of tuberculosis. Moreover, the disease is easily
transmitted to other inmates and staff in congested correctional
facilities like WCDC.
D. Medical Staffing, Policies and Procedures
The deficiencies in the Detention Center's chronic care and
access to medical services are largely due to inadequate staffing
and a lack of written policies and procedures. WCDC operates its
medical department with very few written policies or procedures.
The lack of routine procedures, for example, a policy governing
follow-up appointments for individuals with chronic medical
conditions, jeopardizes the care provided to inmates and
detainees.
In addition, WCDC has inadequate medical staffing to meet
the needs of its population of over 500 inmates and detainees.
The facility provides only 16 hours of physician staffing per
week and fails to utilize these hours in an optimal manner. In
particular, the physician uses a large portion of his time
performing routine clinical activities, such as sick call
evaluations or treating individuals with less medically
significant sick call complaints, that could be performed by
nursing staff. However, WCDC's nurse practitioner spends much of
her time answering phones and filing charts, instead of providing
sick call evaluations, because WCDC does not employ any
administrative staff for the medical unit. Because of these
staffing shortages, medical records for inmates and detainees are
extremely disorganized, jeopardizing the continuity of care.
III. Mental Health Care
The Detention Center's mental health treatment is deficient,
resulting in a number of untimely mental health interventions.
In addition, there are deficiencies in WCDC's medication
distribution. These problems are largely caused by a lack of
staffing, space and mental health policies and procedures,
including a quality assurance system. While mental health
screening was previously a problem at WCDC, the addition of two
forensic screeners in July 2000, has remedied this problem.
A. Mental Health Treatment
WCDC does not provide adequate mental health treatment,
which may exacerbate the condition of inmates and detainees with
mental illnesses.
The Mental Health Unit, which houses 12 individuals, fails
to provide any meaningful mental health treatment. Treatment
plans are not developed for mentally ill inmates and detainees,
although many have significant mental illnesses. Psychiatrist
coverage is also insufficient to provide adequate evaluation and
treatment. WCDC provided only two hours of psychiatric services
per week for all inmates and detainees combined at the time of
our tour. We understand that WCDC now provides four hours of
psychiatric services per week, an amount that is still
insufficient. Group therapy is not provided to inmates and
detainees in the Mental Health Unit because of a lack of space
and staff resource limitations. Inmates and detainees in this
unit should have more than psychotropic medication and custodial
care to address their severe and persistent mental health needs.
Further, mental health interventions often are untimely,
posing the risk of further deterioration and harm to inmates and
detainees. For example, an April 20, 2000, intake referral
indicated an inmate was taking Zyprexa, which is used to treat
schizophrenia and bipolar disorder, prior to arrival at WCDC. It
appears, however, that this inmate first saw the psychiatrist two
months later, and was only prescribed medication by WCDC on June 29, 2000.
Similarly, an inmate, whose presentation was consistent with
schizophrenia, was placed in the Mental Health Unit in April
1999. A mental status examination in May 1999, concluded this
inmate's medications should be adjusted. However, he was not
seen by a psychiatrist between June and December 1999. This
untimely intervention had been corrected for this individual
inmate by the time of our tour and he appeared reasonably stable.
Finally, WCDC does not have sufficient housing designated
for inmates and detainees with significant mental illnesses.
While the Mental Health Unit can accommodate 12 individuals, the
staff estimated that 25 to 30 male and five female inmates and
detainees met the criteria for treatment in the Mental Health
Unit. In addition to this lack of space, the cells in the Mental
Health Unit were very dirty and malodorous.
B. Medication Distribution
WCDC's staff acknowledged a high rate of medication non-compliance among the mental health caseload of inmates and
detainees. Improper administration of medications required by
mentally ill inmates and detainees can exacerbate their mental
illnesses or cause relapses. As noted above, medical records are
very disorganized, which makes monitoring of medication
compliance extremely difficult and increases the likelihood of non-compliance. The Detention Center's distribution of
medication is also compromised by its use of off-duty
correctional officers without adequate oversight and quality
assurance. This practice increases the likelihood that mentally
ill inmates and detainees will not receive timely and necessary
interventions from mental health staff and may increase
medication non-compliance.
C. Mental Health Staffing, Policies and Procedures
The deficiencies in WCDC's mental health care are largely
due to a lack of staffing, mental health policies and procedures
and a systematic quality improvement process.
Mental health staffing is a significant problem at WCDC. As
noted above, the Detention Center's psychiatrist currently
provides only four hours of coverage per week even though it
houses approximately 60 to 80 individuals with serious mental
illnesses, about 25 to 30 of whom meet the criteria for placement
in the Mental Health Unit.
In addition to the four hours of psychiatric coverage, WCDC
has 1.33 full time equivalent ("FTE") case manager positions.
While the case workers are dedicated and hardworking, they lack
sufficient credentials to provide diagnostic assessments or
mental health therapy. Moreover, WCDC has failed to supervise
the caseworkers adequately. These case workers used to report to
the Program Manager for Forensic Services, but this position was
abolished. These shortages contributed significantly to the
untimely mental health interventions described above.
As with medical care, the lack of site-specific, written
policies and procedures governing mental health services
jeopardizes the care provided to inmates and detainees. Further,
the overall quality of mental health care at WCDC is diminished
by the lack of a quality improvement process. WCDC lacks a
systematic method of identifying problems or designing solutions
in order to improve the provision of care. The absence of a
systematic process makes it extremely difficult to develop and
implement the changes needed in mental health services at WCDC.
D. Mental Health Screening
Mental health screening must be performed in a timely manner
to identify critical needs and prevent suicide and deterioration
of an individual's mental health. Since July 2000, WCDC has
utilized two FTE forensic screeners to conduct mental health
screening examinations. The screeners examine all inmates and
detainees admitted to WCDC who are not released from the
Detention Center within 24 hours. This system appears to work
well and it or a similar system is critical for identifying
inmates and detainees with mental illnesses in a timely fashion.
WCDC funds the screeners through a yearly grant. We understand
that the grant was renewed and is currently in effect.
Continuation of this program is important as our review of
medical records demonstrates that, prior to the implementation of
the screening program, WCDC failed to conduct adequate mental
health intake screening.
IV. Inmate and Detainee Safety
Inmates and detainees are constitutionally entitled to
incarceration in an environment that offers reasonable protection
from harm. WCDC's use of force and force reporting practices and
policies are deficient. In addition, the Detention Center's security administration is deficient, posing a risk of injury to
inmates and detainees.
Our investigation also examined the Detention Center's use
of restraints, particularly the use of the restraint chair. The
Detention Center appears to have used the restraint chair
infrequently in the three years prior to our site visit and our
review of those incidents did not reveal constitutional problems,
although we noted a lack of sufficient detail in reporting its
use. In addition, our consultants noted some problems in WCDC's
restraint policies, such as the restraint chair policy does not
set a limit on the maximum length of time an inmate or detainee
may be restrained.
A. Use of Force
Our review of incident reports revealed a number of
inappropriate and/or unnecessary uses of force by WCDC staff.
For example, an inmate on suicide watch was punched in the eye by
an officer because he "started to spit" on the officer again.
Another inmate, who was locked in a medical cell, was sprayed
with a chemical agent because he "tried to spit" at a passing
officer. The officer later asked if the inmate wished to see a
nurse, received no reply and so apparently took no further
action. WCDC policy requires approval from the Warden or his/her
designee before using chemical spray on an inmate in a cell and
that individuals sprayed with chemical agents be given medical
treatment immediately. Although the report indicated neither was
done in this case, the Duty Supervisor concluded the use of force
was appropriate.
Similar issues were raised when the staff performed a cell
extraction of an inmate who refused to return his food tray and
apparently threatened to throw bodily fluids at officers. One
officer reported that the inmate had stabbed another officer on a
previous occasion, so extra precautions were taken. During the
course of the extraction, which was supervised by a high-ranking
official, the officers used both pepper spray and the stun
shield. The staff then wrapped a towel around the inmate's head,
apparently to prevent spitting. Several problems with the force
used in this incident should have prompted further review by WCDC
administrators, including the use of chemical agents in
conjunction with the stun shield, the use of a towel to wrap the
inmate's head after use of the chemical agent and stun shield and
the failure to check for contra-indications. However, the only
documented review of this incident was performed by officers
directly involved in the use of force.
As evidenced by these incidents, the problems with the use
of force at WCDC are perpetuated by deficiencies in its policies
and practices on reporting and reviewing the use of non-deadly
force. While the policy requires a report be prepared, it only
requires minimal information regarding the incident. In
addition, the policy does not require an independent
investigation of use of force by the staff. Finally, the policy
does not address videotaping cell extractions, or photographing
injuries resulting from a use of force.
Although there was no final policy on the use of electronic
restraints, we were provided with a draft policy. The draft does
not identify conditions where it should not be used, such as when
water is present or when aerosol chemical agents are used.
Moreover, it does not require a check for medical contra-indications. These gaps in policy expose inmates and detainees
to an increased risk of physical harm.
B. Security Administration and Protection from Harm
WCDC does not adequately protect inmates and detainees from
harm. This is due to problems in the classification and housing
of inmates and detainees, understaffing, inadequate training and
surveillance problems.
A system of inmate housing based upon objective,
behaviorally-based criteria is critical to providing a reasonably
safe environment. Based on our investigation, WCDC utilizes an
objective classification system (dividing inmates and detainees
into minimum, medium and maximum security) and classifies inmates
and detainees in a timely fashion. However, WCDC does not have
the flexibility in housing space required to separate the
population by classification because it is so crowded.
New inmates and detainees are randomly assigned a bed, based
on availability. While some mixing of classifications is not
unusual, such as minimum with medium security, mixing minimum
security inmates with maximum security inmates increases the risk
of inmate violence against other inmates. WCDC does not have
protocols for what classifications should be mixed, for how long
or with what precautions. For example, it is inappropriate to
mix minimum security inmates or detainees with maximum security
individuals who have recently engaged in assaultive behaviors.
The Detention Center's ability to protect inmates and
detainees from harm is also compromised by understaffing. WCDC
had approximately 90 line officers available for assignment in
the general population areas at the time of our visit. There
were several indications of this shortage. For example, there
are often only one or two movement officers per shift in the
entire facility to fulfill a wide range of duties, from
supervising inmates and detainees participating in programs to
assisting in inmate and detainee meal distribution. Similarly,
there were no officers with fixed-post assignments in Special
Housing. This staffing shortage compromises the delivery of
basic services and security functions, such as rounding and
escorting inmates and detainees. These sorts of lapses in
security increase the likelihood of inmate violence, escapes, and
suicides. The problems arising from the staffing shortage at
WCDC are aggravated by the lack of a centralized staffing roster
to evaluate shortages and inadequate training, particularly a
lack of training on use of force tactics and the use of
restraints.
Currently, WCDC requires its staff to conduct three rounds
of inmate-occupied areas per shift. We noted several problems
with WCDC's inmate surveillance equipment and procedures that
increase the risk of physical harm to inmates and detainees and,
therefore, increase the importance of rounding by the staff of
these areas. For example, the one-way glass in the control
centers for B and C Blocks impairs sight lines into the
individual pods of these cellblocks. The view of some areas of
these pods are also obstructed, such as the areas where inmates
and detainees are housed under the stairwells. Rounds of areas
out of direct sight of the control center should be performed
more frequently than three times per eight-hour shift.
V. Environmental Health and Safety
WCDC's environmental health and safety practices and
procedures are deficient in the following areas: sanitation;
food service; inmate clothing, bedding and supplies; and physical
plant.
WCDC is significantly overcrowded, exacerbating the
unconstitutional conditions we identified at the facility.
Specifically, overcrowding at WCDC increases the risk of the
spread of infection and, as discussed above, the difficulty
ensuring inmate and detainee security. For example, space in the
Male Work Release Unit and the Kitchen Trustee dormitory is less
than one-fourth that recommended by public health standards to
minimize the spread of secondary infections and provide safe
egress during an emergency. Problems with overcrowding are
magnified on weekends, because the Detention Center must house a
number of weekend detainees. During our visit, five female
weekenders were housed in one cell in the booking area. These
inmates had no out-of-cell time, no shower access and limited
hygiene opportunities for three days.
A. Sanitation
We found several problems with WCDC's sanitation practices
that pose significant health risks. The most significant
deficiency was that the trays used for food service are not
properly sanitized between uses posing a risk of spreading food-borne illnesses. The dishwasher used for cleaning the trays
cannot handle the volume of trays processed at the facility, did
not reach the necessary pasteurization temperature of 160 and
the spray from the dishwasher does not adequately clean the food
contact surface. Because of these problems, inmate workers use
unsanitary rags to remove food from the trays after they are
taken from the dishwasher.
Inmate staff in the kitchen do not practice basic hand-washing techniques. For example, we observed an inmate
portioning food without gloves or washing his hands. Even with
proper instruction, there was no soap at the hand-washing sink in
the kitchen and it was used for utensil storage during food
preparation. We also noted problems in the infirmary, where the
sinks are not elbow or foot operable, allowing cross
contamination.
We observed a number of other sanitary problems during our
tour. In the kitchen, several areas were not adequately
sanitized, such as the can opener and a baker's table used for
food preparation, and the food-tray preparation area was too
close to the tray scrapping and rinsing area. In the dental
clinic, we observed what appeared to be mucus on the handles of
the examination light and there was also no biological monitoring
device to ensure the autoclave was providing proper
sterilization. Many cells and sleeping areas were very dirty,
increasing the risk of illness spreading. Cleaning supplies and
implements are not readily available, especially in the medical
and specialty housing areas, and inmates do not have scheduled
access to cleaning supplies.
B. Food Service
We observed deficiencies in food preparation and storage at
WCDC. The Detention Center fails to heat foods sufficiently
during cooking or maintain them at temperatures high or low
enough to minimize microbial growth, which may result in the
spread of food-borne illnesses. For example, during our visit,
we found the temperature of three hotel pans of recently
reconstituted mashed potatoes significantly below the temperature
level necessary to prevent microbial growth. In addition, we
observed trays of prepared food sitting out for over one hour.
After this amount of time, foods were no longer hot or cold
enough to minimize the risk of spreading food-borne illnesses.
Similarly, there were deficiencies in temperature control in
the walk-in refrigerator. During our visit, the temperature
measured was too high to minimize microbial growth, increasing
the risk of spreading food-borne illnesses.
C. Inmate Clothing and Supplies
There are deficiencies in WCDC's issuance and maintenance of
clothing and bedding that result in unsanitary conditions,
facilitating the spread of disease. While the INS detainees at
the Detention Center appear to receive the full allotment of
clothing and bedding, most of the other detainees and inmates are
issued only one set of each. Moreover, the supplies that are
issued are not properly maintained.
Most of the mattresses observed in WCDC were in extremely
poor condition, including those in the infirmary. The plastic
covers were cracked, soiled and flaking off, making them
impossible to sanitize between inmates and detainees.
During our tour, we observed numerous prisoners wearing
extremely soiled underwear and jump suits and most of the sheets
we observed were extremely soiled. As noted above, most inmates
are issued one set of clothing and bedding. In order for inmates
to get their clothing cleaned, they must turn in their one set
for several hours. As a result, many inmates do not surrender
their clothing for laundry. Similarly, inmates complained that
sheets and pillowcases were in short supply and, therefore, it
was uncertain whether bedding sent to the laundry would be
returned. The supply shortage at WCDC is exacerbated by problems
with the laundry facility, including a lack of capacity and
equipment failures. This poses a significant hygiene problem
that facilitates the spread of disease.
D. Physical Plant
Our inspection revealed several health and safety concerns
related to the facility's ventilation and plumbing systems. A
detailed inspection of the ventilation system revealed that poor
design, installation, and maintenance causes wide disparities in
temperature and ventilation throughout the facility, and even
between cells in the same cell block.
For example, 37 percent of the cells sampled had little to
no air movement. In addition, the air in the female dormitory
was stale, humid and malodorous, and we detected no air movement.
Poor air circulation increases the risk of contracting
respiratory infections and may exacerbate existing respiratory
illnesses, particularly given the crowding at WCDC.
The hot water system supplies water at too high a
temperature, apparently in an attempt to compensate for a lack of
capacity. During off-peak periods, the hot water is
significantly above scalding temperature. For example, the water
supplied to the infirmary cells was measured at 152, 32 above
scalding temperature. This poses a significant risk of physical
injury to inmates and detainees.
VI. Recommended Remedial Measures
In order to rectify the identified deficiencies and to
protect the constitutional rights of the facility's inmates and
detainees, the Detention Center should implement, at a minimum,
the following measures:
A. Medical Care
1. Develop site-specific written policies and procedures
governing the provision of health care, including medication
distribution.
2. Arrange for sufficient nursing staff to provide sick-call evaluations, supervise intake medical screenings, supervise
the distribution of medication and provide back-up nursing
coverage in case of illness or vacations.
3. Provide physician staffing sufficient to ensure access
to medical care, particularly for inmates and detainees with
chronic conditions.
4. Provide sufficient and appropriate staffing to ensure
that medical records are complete and accurate to maintain
continuity of care.
5. Develop and implement a policy that ensures access to
sick call for inmates and detainees in the BAU.
6. Provide all necessary medical care to indigent inmates
and detainees, particularly medically indicated eyeglasses.
7. Begin a chronic care program that includes appropriate
screening, monitoring and follow-up care.
8. Require tuberculosis testing of all inmates and
detainees, unless there is documentation that the individual
tested negative within the preceding three months or previously
tested positive for tuberculosis.
B. Mental Health Care
1. Develop comprehensive site-specific mental health care
policies and procedures, including medication distribution.
2. Ensure that mental health care records are complete and
accurate to maintain continuity of care, particularly regarding
the administration of medications.
3. Obtain additional mental health care staffing, including
additional licensed mental health clinicians and psychiatric
services sufficient to ensure adequate diagnostic assessments,
mental health treatment and therapy, timely mental health
intervention and adequate record keeping.
4. Develop and implement enhanced mental health programming
in the Mental Health Unit.
C. Security and Protection from Harm
1. Develop and implement a protocol for housing inmates and
detainees based on their classification. This protocol should
address what classification levels may be mixed, under what
circumstances and establish time limits on how long they may be
mixed. It should also address identifying and acting to separate
individuals within a classification who should not be mixed.
2. Hire sufficient staff to supervise inmates and detainees
and ensure the safety and security of inmates, detainees and
staff.
3. Design and implement a system for tracking security
staffing throughout the institution.
4. Provide security staff with sufficient training,
particularly in-service training regarding use of force,
restraints and chemical agents.
5. Ensure frequent and documented rounds are made by staff
for inmate areas that are not observable from the control
centers.
6. Develop and implement a policy that requires adequate
reporting and independent review of use of force by the staff.
7. Change the policy on the use of chemical agents to
require decontamination procedures and a check for medical
contra-indications before use, if time permits.
8. Develop and implement policies regarding the use of
restraints.
D. Environmental Health and Safety
1. Repair the ventilation system to operate properly and
then maintain its proper operation.
2. Ensure food is stored, prepared, and served in a
sanitary manner.
3. Provide appropriate access to cleaning supplies to
inmates and detainees in the housing areas.
4. Provide mattresses that can be properly sanitized
between inmates or detainees.
5. Provide adequate laundry facilities for the demand at
the Detention Center and issue all inmates two full sets of
clothing and bedding so that they may be properly laundered.
6. Adjust the temperature of the hot water supplied to
inmate areas to below the scalding temperature of 120.
7. Implement proper sanitation practices in the dental
clinic.
We will forward our expert consultants' reports under
separate cover. Although the experts' reports and work do not
necessarily reflect the official conclusions of the Department of
Justice, their observations, analyses and recommendations provide
further elaboration of the issues discussed above, and offer
practical assistance in addressing them.
Pursuant to CRIPA, the Attorney General may institute a
lawsuit to correct deficiencies of the kind identified in this
letter forty-nine days after appropriate officials have been
notified of them. 42 U.S.C. § 1997b(a)(1). We would prefer,
however, to resolve this matter by working cooperatively with
you, and we have every confidence that we will be able to do so.
Sincerely,
/s/ Ralph F. Boyd, Jr.
Ralph F. Boyd, Jr.
Assistant Attorney General
cc: Edgar A. Baker, Jr., Esq.
County Attorney
Wicomico County
Thomas M. DiBiagio, Esq.
United States Attorney
District of Maryland
Douglas C. Devenyns
Director
Wicomico County Department of Corrections
Owen B. Cooper
General Counsel
Immigration and Naturalization Service
Updated July 25, 2008
